PROVIDENCE HEALTH & SERVICE WASHINGTON (NPI# 1124226360) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124226360 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICE WASHINGTON |
| Other Organization Name | PROVIDENCE ADDICTIONS RECOVERY CTR |
| Practice Address |
1800 Cooks Hill Rd Suite G Centralia WA 98531-9072 |
| Mailing Address |
Po Box 34439 Seattle WA 98124-1439 |
| Practice Telephone | 3608278200 |
| Practice Fax Number | 3608278367 |
| Mailing Telephone | 4255256778 |
| Mailing Fax Number | 4255256700 |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2010-12-22 |
| Authorized Official Name | NICOLE QUINN (PAYOR CREDENTIALING MANAGER) |
| Authorized Official Telephone | 4255256715 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
WA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | UBI MASTER LICENSE | 602 399 531 | 01 |
| WA | CITY OF CHEHALIS BUSINESS | 15835 | 01 |
| WA | CERT OF APPROVAL CHEM DEP | 21 0354 00 | 05 |
| Other Name | Type Code |
|---|---|
| Providence Addictions Recovery Ctr | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104024348 | Providence Health & Service Washington | Psychologist | 218-a Main Street, Morton, WA 98356-0000 | 2007-07-10 |
| 1245438738 | Providence Health & Service Washington | Psychologist | 1322 Commerce Ave, Longview, WA 98632-3718 | 2007-07-05 |
| 1124117197 | Providence Health & Service Washington | Clinic/Center | 1010 South Scheuber Rd, Suites 3 & 4, Centralia, WA 98531-8892 | 2006-10-11 |
| 1447490370 | Providence Health & Service Washington | Surgery | 1720 Cooks Hill Rd, Centralia, WA 98531-9071 | 2009-03-05 |
| Street Address |
1800 COOKS HILL RD SUITE G |
| City | CENTRALIA |
| State | WA |
| Zip Code | 98531-9072 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649267196 | Loren D Cooper | Internal Medicine | 1800 Cooks Hill Rd, Suite B, Centralia, WA 98531-9072 | 2005-09-30 |
| 1316339385 | Justin Charles Cooper | Physician Assistant | 1800 Cooks Hill Rd, Suite F, Centralia, WA 98531-9072 | 2015-02-26 |
| 1093150914 | Sheila Ann Cichoski | Massage Therapist | 1800 Cooks Hill Rd, Suite A, Centralia, WA 98531-9072 | 2013-05-06 |
| 1437418175 | Lewis County Community Health Services | Clinic/Center | 1800 Cooks Hill Rd, Suite G, Centralia, WA 98531-9162 | 2012-05-15 |
| 1336430966 | Jacqueline Register | Massage Therapist | 1800 Cooks Hill Rd, Suite A, Centralia, WA 98531-9072 | 2011-04-30 |
| 1649574682 | Stephen Bentley | Massage Therapist | 1800 Cooks Hill Rd, Suite A, Centralia, WA 98531-9072 | 2011-01-05 |
| 1902115371 | Medical Massage Inc | Massage Therapist | 1800 Cooks Hill Rd, Suite A, Centralia, WA 98531-9072 | 2010-10-01 |
| 1194031138 | Stephanie Feuchter | Massage Therapist | 1800 Cooks Hill Rd, Suite A, Centralia, WA 98531-9072 | 2010-08-27 |
| 1912213943 | Linda Young | Massage Therapist | 1800 Cooks Hill Rd, Suite A, Centralia, WA 98531-9072 | 2010-08-27 |
| 1639485675 | Krista Hilleary | Massage Therapist | 1800 Cooks Hill Rd, Suite A, Centralia, WA 98531-9072 | 2010-08-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306462205 | Jelisa Renae Thomas | Counselor | 3510 Steelhammer Ln, Centralia, WA 98531 | 2020-06-17 |
| 1205498607 | Jennifer Kristine Mcglynn Paterno | Counselor | 2428 W. Reynods Ave, Centralia, WA 98531 | 2019-07-05 |
| 1538646328 | Adam Jeffrey Moore | Counselor | 3510 Steelhammer Lane, Centralia, WA 98531 | 2018-07-24 |
| 1144706698 | Euijeong Kim | Occupational Therapist | Rehabilitation Therapies, 914 S. Scheuber Rd, Centralia, WA 98531 | 2018-07-18 |
| 1104315266 | Margaret Fowler Floyd | Registered Nurse | Centralia High School, 813 Eshom Road, Centralia, WA 98531 | 2018-05-04 |
| 1124545777 | Samantha Michelle Moody | Speech-Language Pathologist | Centralia School District, 2320 Borst Ave, Centralia, WA 98531 | 2017-08-24 |
| 1821520289 | Alexa Franks | Behavior Technician | 2428 West Reynolds Ave., Centralia, WA 98531 | 2017-04-03 |
| 1023559861 | Brandy Michelle Peterson | Counselor | 135 W. Main Steet, Centralia, WA 98531 | 2017-03-13 |
| 1841738812 | Graceful Healing Naturopathic | Naturopath | 219 N Tower Ave, Suite 304, Centralia, WA 98531 | 2017-02-09 |
| 1043681513 | Angela Naillon | Counselor | 2428 West Reynolds, Centralia, WA 98531 | 2015-10-09 |
| Find all providers in zip 98531 | ||||
| Taxonomy Code | 103TA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710411830 | Rickey L Jones | Psychologist | 5523 E Commerce Ave, Spokane, WA 99212-1306 | 2017-04-14 |
| 1851849855 | Yvonne Lynn Prouty | Psychologist | 1960 Thompson Dr, Sedro Woolley, WA 98284-5007 | 2016-09-19 |
| 1205088689 | Diedra L Clay | Psychologist | 2800 E Madison St Ste 320, Seattle, WA 98112-4871 | 2008-10-16 |
| 1659521912 | Wayne E Carr | Psychologist | 7800 N E Bothell Way, Suite 155 B, Kenmore, WA 98028 | 2008-09-23 |
| 1104024348 | Providence Health & Service Washington | Psychologist | 218-a Main Street, Morton, WA 98356-0000 | 2007-07-10 |
| 1245438738 | Providence Health & Service Washington | Psychologist | 1322 Commerce Ave, Longview, WA 98632-3718 | 2007-07-05 |
| 1245208404 | James William Ethier | Psychologist | 238 N. Chelan Ave., Wenatchee, WA 98801-2105 | 2006-03-14 |
| 1689272395 | Kathryn Staats | Psychologist | 1016 Commercial St, Raymond, WA 98577-2631 | 2020-10-14 |
| 1992315519 | Christine Borland | Psychologist | 5929 Westgate Blvd Ste A, Tacoma, WA 98406-2567 | 2020-08-07 |
| 1750916086 | Ozark Gore | Psychologist | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2020-03-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.